WHD_2014_Where Research Meets Design

WHERE RESEARCH MEETS DESIGNUsing Parametric Modeling to Optimize Walking Distances and Enhance Workflow

• Adeleh Nejati, MArch, EDAC

• Tom Harvey, FAIA, MPH, FACHA, LEED AP

• Upali Nanda, PhD, Assoc. AIA, EDAC

• Heath May, AIA

• Ryan Gathmann, AIA

WHY RESEARCH IS “IN”

3INITIATIVES

PARAMETRIC MODELING

• Designing a process rather than a form

• Designing a reusable and configurable process

• Creating a nearly infinite number of variations from one rule set of inputs, decisions and actions

• Optimizing by quickly creating,

testing and comparing multiple

options

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PARAMETRIC MODELING

THEORETICAL FRAMEWORK

DRIVER(MANIPULATED FEATURE)

Distance from a Patient Room to: • Medication Room• Clean Supply room• Soiled Utility Room• Equipment Holding room• Crash Cart Alcoves• Documentation Station(s)

DRIVEN LEVEL 1ENVIRONMENTAL QUALITY

• Walking Distance- PR to Support Area- Support to Support- Support to PR

DRIVEN LEVEL 2HUMAN OUTCOME

• Time in Bed-side Care• Time in Non-Value

Added Activities• Nurse Fatigue

DRIVEN LEVEL 3HUMAN/ ORGANIZATIONAL OUTCOME

• Med Errors• Falls• HCAHPS• Nurse Retention

CONSTRAINT(CONTROL/CONFOUND)

• Room Size• Unit Size• Minimum Clearances

(patient bed, toilet)• Maximum Distance

THEORETICAL FRAMEWORK

CASE STUDYCentralized vs. Decentralized Nurse Stations

PATIENT ROOMS

CENTRALIZED NURSE STATIONS

36

3

METHODIST CHARLTON HOSPITAL

DALLAS, TX

DECENTRALIZED NURSE STATIONS

18

Each nursing unit in this hospital has:

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METHODIST CHARLTON HOSPITAL

DALLAS, TX

Scenario 1

Scenario 2

Scenario 3

36 Bed Unit

METHODIST CHARLTON HOSPITAL

DALLAS, TX

Scenario 1

Location ActivityMinimum Roundtrips

per Primary Shift1

Documentation Station(s) Documentation 10.0

Consultation/Collaboration

Socialization

Medication Room Meds Management/Admin 5.0

Med Prep

Med Supply Acquisition

Clean Utility Room Supply Use Management/Admin 3.0

Medical Supply Acquisition

Clean Linen Acquisition

Soiled Utility Room Waste Disposal 2.0

Dirty Equipment Holding

Soiled Linen Holding

Equipment Holding Room Equipment Storage 1.0

Broken Equipment Holding

Nourishment Room - Meals Food Tray Hold/Retrieval 3.0

Used Tray Holding

Nourishment Room - Ice/Snacks Snack/Drink Acquisition 4.0

Ice Pack Acquisition

Break Room Personal Effects Access/Toilet 3.0

Education

Respite

Patient Transport (Service Elevators) Link to Surgery, Imaging, Other D&T 0.2

Link to other Bed Units

Link to Discharge (Lobby)1These figures are theoretical assumptions for purposes of this study. Actual trip counts measured through shadowing in the field often show higher frequencies.

Round Trip and Distance Parameters for Nurse Travel from Patient Rooms

METHODIST CHARLTON HOSPITAL

DALLAS, TX

Patient Room 1

Patient Room 2

Patient Room 3

Patient Room 4

TOTAL

Centralized 0.673 0.708 0.681 0.819 2.881

Scenario 1 Decentralized 0.491 0.549 0.55 0.67 2.26

% reduced %27.0 %22.5 %19.2 %18.2 %21.6

Centralized 0.857 0.831 0.805 0.796 3.289

Scenario 2 Decentralized 0.702 0.635 0.56 0.509 2.407

% reduced %18.0 %23.6 %30.4 %36.0 %26.8

Centralized 1.346 1.183 1.167 0.952 4.647

Scenario 3 Decentralized 1.063 0.942 0.929 0.795 3.729

% reduced %21.0 %20.3 %20.4 %16.5 %19.8

METHODIST CHARLTON HOSPITAL

DALLAS, TX

Walking Distance for Centralized vs. Decentralized Nurse Stations

METHODIST CHARLTON HOSPITAL

DALLAS, TX

0.000

0.200

0.400

0.600

0.800

1.000

PR1 PR2 PR3 PR4

Scenario 1

0.000

0.200

0.400

0.600

0.800

1.000

PR1 PR2 PR3 PR4

Scenario 2

0.000

0.500

1.000

1.500

PR1 PR2 PR3 PR4

Scenario 3

0.000

0.500

1.000

1.500

2.000

2.500

3.000

3.500

4.000

4.500

5.000

Scenario 1 Scenario 2 Scenario 3

Centralized Nurse Station

Decentralized Nurse Station

Walking Distance for Centralized vs. Decentralized Nurse Stations

21.6%26.8%

19.8%

IMPLEMENTATION IN PRACTICE

WINGS

NURSE STATIONS

2

4

PROMEDICA TOLEDO HOSPITAL

TOLEDO, OH

PATIENT ROOMS

40

Each nursing unit in this hospital has:

40 Bed Unit

20 Beds

20 Beds

200.075

115

83

81.55

79.725

68.25

59.875

59.325

50.8

24.125

0 50 100 150 200 250

Break Room

Nourishment

Conference

Soiled Work

Equipment

Ice

Main Nurse Station

Meds

Linen

Wow Stations

AVERAGE DISTANCE FROM PR TO SUPPORT SPACES

NURSE WALKING DISTANCES

Excessive Distance

Reasonable Distance

UNIT AREAS

PA

TIE

NT

RO

OM

S

IMPLICATIONSFUTURE RESEARCH

• Increased value of care giver time – by optimizing time with the patient rather than time wasted in hunting and gathering activities.

• Enhanced understanding of design implications – informed by quality data relative to spatial configurations on the workflow, unit organization and human behavior

• Enabled purposeful scenario planning of workflow, space allocation and spatial configurations that then inform operational planning and space programming that drive design goals.

IMPLICATIONS

• Building a tool providing the planner/designer with the ability to set a specific criteria of maximum threshold for walking distances, and input parameters related to the specific site and program to generate geometry within a parametric model.

• Building a generic solver to automate the process of iteration and allow for numerous alternates to be tested against user-defined criteria and sorted for fitness.

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FUTURE RESEARCH

Thank you for your attention